Clinical cases

Introduction: Prurigo nodularis (PN) is a dermatosis
of unknown etiology, characterized by extremely pruritic
papules and nodules symmetrically located on the extensor
sides of the limbs and sometimes on the trunk. The etiology
of PN has been associated with thyroid diseases, diabetes,
chronic renal failure, cholestatic autoimmune hepatitis,
internal neoplasia, HIV and HCV infection and psychiatric
disorders. We present the case of a female patient with PN
associated with autoimmune polyendocrinopathy.
Clinical case: A 43 years old female patient known
with PN for about 10 years, with type 1 insulin-dependent
diabetes mellitus complicated with stage 3 chronic kidney
disease, with Basedow-Graves disease since 2014, is
admitted into our clinic in October 2017 with the following
accuses: progressively altering neuromuscular asthenia,
gastrointestinal disturbances, progressive hyperpigmentation
of the skin, intensely pruritic, hyperpigmented
nodules symmetrically disseminated on the trunk, limbs
and face. Corroborating clinical and laboratory data, the
diagnosis of Addison's disease in the context of autoimmune
polyendocrinopathy was established. Histopathological
examination of a skin nodule indicated the
diagnosis of PN. For the skin disorder, 200 mg dapsone
therapy was indicated, gradual disappearance of nodules
and pruritus has been observed, residually remaining small
atrophic and achromic scars.
Conclusions: The particularity of this case is the
association of nodular prurigo with three autoimmune
diseases during an autoimmune polyendocrinopathy: type
1 insulin-dependent diabetes mellitus, Graves’ disease and
Addison disease.